American hospitals are quickly running out of resources during this devastating time. It’s not simply a lack of protective equipment and COVID-19 testing – health care workers are rapidly becoming exposed, which limits their ability to care for patients. One particularly vulnerable resource in danger of being exhausted: doctors in training. Historically, the American health care system has leaned on resident physicians. For little pay, resident physicians work strenuous, long hours. In addition to regular day shifts, they work overtime while on-call – shifts as long as 24 hours. As their attending physicians advise, they are often the ones who put in the longest hours at patient bedsides – finishing the last stitches over the surgical table or rushing to give a consultation on the other side of the hospital. They do so for the benefit of their training, an exchange of hard work for education. Sometimes the hard work mandated by hospital administrations puts residents at risk for burnout, or even a decline in mental health. Now, in a national emergency, when patient safety must be prioritized above all, residents are more endangered than ever.
As a resident working in a city hospital in NYC, I have witnessed with despair how COVID-19 has strained the medical system over the past couple of weeks. Hospitals have scrambled to adapt in order to prevent further infection, issuing new policies and strategies by the hour. Unfortunately, the policies and equipment did not arrive before COVID-19, and this has left all health care workers exposed. The lack of choice that residents experience as they work tirelessly to fight COVID-19 leaves them particularly vulnerable. While other doctors have more of a choice where and how they work, residents have determinedly less of a voice as they are reassigned to needed roles. Residents are currently being redeployed to work for COVID-19 units, even if they signed for a different specialty. Pediatric residents are now seeing adults. Residents based in outpatient specialties are now in ICU and the ER every day. We experience anxiety about doing work we did not imagine as part of our careers. We are sleepless at night; we don’t know what we will be called on to do or whether we will be protected when we are drafted. We have been assigned to be at the front lines, and most of us will work tirelessly until our breaking point because we don’t know anything else.
Residents follow orders quickly and without complaint, but we are often afraid to admit to the psychological burden. For years, paternalistic medical culture has valued silent obedience over truthful expressions of discomfort or fatigue. This system attracts doctors in training who are eager to put a patient’s well-being in front of their own. This is unquestionably noble behavior, but in a pandemic, it has the potential to be harmful. We will work long hours when we are told and risk exposure without the proper protective equipment. We will cancel any upcoming vacations and accept that in the next few months, we will live in the hospital. For those of us training far from home, this means not knowing when we will next see our families. We continue to wait for the hospital administration to decide how and where we will work. We accept these conditions because we care, but also because we are expected to put others first even if it means risking our own physical and mental health.
This expectation does not only arise from internal pressure to help others – external shame is a significant driving factor. The pressure we face from those who outrank us easily thwarts our efforts at self-preservation. Whether it is subtle or frighteningly blatant, the message we receive from above is clear: we should be devoting our entire selves to our patients and hospitals. When we hesitantly express worries for our own health or dare to think of how our own personal lives are affected, we hear, “you signed up for this.” The thing is, we didn’t. We signed up to be doctors, not martyrs. We signed up to be allowed to use our own clinical judgment to assess what is right for patient safety as well as our own. Not shamed into submission when those above us do not plan accordingly. Our concerns are dismissed as hysterical; our worries are turned into weaknesses. We second-guess our fears as cowardly, and see our stress as failure. Soon enough, we are giving in because it is easier than fighting. We know from experience that no matter how loud we try to be, our voices are always softer.
While residents have proudly tackled this pandemic with little consideration for their own needs, their sacrifice should not go unnoticed. We are willing to put ourselves at risk, but this does not mean we should work without protection. We diligently perform tasks, but our health should not be treated so carelessly. We deserve a working environment in which we care for patients while hospitals care for us, even in a national emergency. This would sustain a currently dwindling resource, rather than exhaust it before it has a chance to make a difference for us all.
Gali Hashmonay is a psychiatry resident.
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